Virtual Training Is More Cost-Effective Than In-Person Training for Preparing Staff to Implement Contingency Management

Bryan Hartzler*, Jesse Hinde, Sharon Lang, Nicholas Correia, Julia Yermash, Kim Yap, Cara M. Murphy, Richa Ruwala, Carla J. Rash, Sara J. Becker, Bryan R. Garner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Behavior therapy implementation relies in part on training to foster counselor skills in preparation for delivery with fidelity. Amidst Covid-19, the professional education arena witnessed a rapid shift from in-person to virtual training, yet these modalities’ relative utility and expense is unknown. In the context of a cluster-randomized hybrid type 3 trial of contingency management (CM) implementation in opioid treatment programs (OTPs), a multi-cohort design presented rare opportunity to compare cost-effectiveness of virtual vs. in-person training. An initial counselor cohort (n = 26) from eight OTPs attended in-person training, and a subsequent cohort (n = 31) from ten OTPs attended virtual training. Common training elements were the facilitator, learning objectives, and educational strategies/activities. All clinicians submitted a post-training role-play, independently scored with a validated fidelity instrument for which performances were compared against benchmarks representing initial readiness and advanced proficiency. To examine the utility and expense of in-person and virtual trainings, cohort-specific rates for benchmark attainment were computed, and per-clinician expenses were estimated. Adjusted between-cohort differences were estimated via ordinary least squares, and an incremental cost effectiveness ratio (ICER) was calculated. Readiness and proficiency benchmarks were attained at rates 12–14% higher among clinicians attending virtual training, for which aggregated costs indicated a $399 per-clinician savings relative to in-person training. Accordingly, the ICER identified virtual training as the dominant strategy, reflecting greater cost-effectiveness across willingness-to-pay values. Study findings document greater utility, lesser expense, and cost-effectiveness of virtual training, which may inform post-pandemic dissemination of CM and other therapies.

Original languageEnglish (US)
Pages (from-to)255-264
Number of pages10
JournalJournal of Technology in Behavioral Science
Issue number3
StatePublished - Sep 2023


  • Contingency management
  • Implementation research
  • Therapy training
  • Virtual instruction

ASJC Scopus subject areas

  • Health(social science)
  • Human-Computer Interaction
  • Applied Psychology
  • Computer Science Applications


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